Post splenectomy related pulmonary hypertension

Abstract

Splenectomy predisposes patients to a slew of infectious and non-infectious complications including pulmonary vascular disease. Patients are at increased risk for venous thromboembolic events due to various mechanisms that may lead to chronic thromboembolic pulmonary hypertension (CTEPH). The development of CTEPH and pulmonary vasculopathy after splenectomy involves complex pathophysiologic mechanisms, some of which remain unclear. This review attempts congregate the current evidence behind our understanding about the etio-pathogenesis of pulmonary vascular disease related to splenectomy and highlight the controversies that surround its management.

Relationship between portopulmonary hypertension and splenectomy: Mayo Clinic experience and review of published works

“…4,8 Of potential interest is that splenectomy has been associated with different types of pulmonary hypertension (WHO Groups 1, 4, and 5), yet is a therapy that has been used to treat complications of portal hypertension. 6,7,[9][10][11][12] To our knowledge, the relationship between splenectomy and POPH has not been described to date. The goals of this observational study were to describe the frequency of splenectomy in POPH as well as possible relationships among POPH-associated liver diseases.…”

Aortic Valve Replacement in a Patient with β-Thalassemia

“…Splenektomiden sonra pnömoni ve plevral efüz-yon gibi pulmoner komplikasyonların geliştiği açık olarak bilinmekle birlikte, splenektominin pulmoner hipertansiyon için tek başına bir etken olduğuna dair yeterli kanıt yoktur. Başka faktörlerle beraber pulmoner hipertansiyon gelişimine uygun zemin hazırladığı üzerindeki araştırmalar devam etmektedir [11] . Olgumuzda da geçirilmiş splenektomi öyküsünün bulunması ve preoperatif değerlendirmede pulmoner arter basıncının 55 mmHg olarak tespit edilmesi splenektomi ile pulmoner hipertansiyon arasındaki ilişkiyi destekler niteliktedir.…”

Pulmonary hypertension in chronic hemolytic anemias: Pathophysiology and treatment

“…With the strong associated risk of splenectomy and pulmonary hypertension in hemolytic disorders, treatment should be focused on the prevention of the need for splenectomy [79]. In particular, 32% of thalassemia patients were shown to develop pulmonary hypertension post-splenectomy (defined as echocardiographic estimate of PAP > 35 mmHg) in a study of 68 patients.…”